Drug Utilization Review (DUR)

At PMN, we understand the significant role that DUR plays in work comp Rx claims administration. Most plans attribute a 10-20% cost avoidance due to DUR programs, especially when used with quantity limit programs. Our DURs incur no separate fees.

Our analysis includes mail order and retail pharmacy in order to capture your entire organization's utilization. This complete picture allows the best opportunity for program enhancements, new feature introductions and management opportunities such as the quantity limitation programs. It also permits us to correct issues such as inappropriate drug use by patients or prescribing physicians with remedies that may include:

Patient education

Clinical pharmacist consultation

Physician letters

Physician phone calls

DUR reporting is done on a quarterly basis. Plus, you may elect hard edits for any or all of our DUR programs.

Three-tier approach to DURs

Verifications done in seconds:

Pharmacy participation verification

Group eligibility verification

Member eligibility verification

Group specific exclusions

Clinical prior authorization

Any of the following will halt processing and require a call to PMN for verification: